Ethics and Burnout

The New England Journal of Medicine today published a brief piece examining burnout among healthcare providers. Certainly, this is a problem both for patients as well as for healthcare providers who of course require appropriate support in their jobs as well as opportunities for rest and renewal.

What struck me in particular about the article is that it opens by referring to the widely accepted ethical framework of beneficence, nonmaleficence, autonomy, and justice. I cannot help but wonder if there is some way in which this framework is itself contributing to burnout.

For example, in many situations, patient autonomy almost always trumps all other considerations, which, at the extreme, threatens to turn physicians, nurses, and other providers into mere technicians who simply fulfill patient requests.

Given the burnout crisis in medicine, it seems to me that it is at least worth asking whether there are ways in which this framework is part of the problem. Is there some other ethical framework, some other way of conceiving of the doctor-patient relationship that might help to alleviate burnout?

Perhaps, for example, if the physician-patient relationship was governed by a covenantal or Hippocratic model, where medical providers and patients (and patient families) view themselves in an ongoing relationship of both giving and receiving, of mutual respect, of seeking understanding, and of looking at the larger place of the practice of medicine in the overall scheme of life and community, the phenomenon of burnout might not be as prevalent.

It certainly seems like a question worth asking, like an avenue worth pursuing.